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General NPI Number Information
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NPI Number | 1144975111
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Entity Type | Organization
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Legal Business Name | MANIFESTING GREATNESS THERAPY LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 4000 DUNWOODY PARK APT 5121
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City | ATLANTA
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State | GA
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Zip | 30338-7966
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Country | US
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Telephone | 470-890-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 DUNWOODY PARK APT 5121
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City | ATLANTA
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State | GA
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Zip | 30338-7966
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Country | US
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Telephone | 470-890-2900
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | LATESHA SHADAWN MITCHELL
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Credential | LMFT
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Telephone | 912-247-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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